Traditional Osteopathy and the General Osteopathic Treatment: A Historical Concept and a Modern Application

Historically, Andrew Taylor Still, MD, DO, differentiated osteopathic medicine from allopathic medicine with its unique approach to treatment using manual therapy. Those treatments, known as osteopathic manipulative treatment (OMT), are currently used to treat somatic dysfunction. The Educational Council on Osteopathic Principles (ECOP) includes different treatment methods, such as muscle energy, high-velocity, low-amplitude, Still techniques, myofascial release, and counterstrain, amongst others, under the category of OMT. Conversely, osteopathic practitioners outside the USA, mostly from Europe, use some techniques that are not necessarily documented as OMT by the ECOP. This is the case of the General Osteopathic Treatment (GOT). The GOT found its origin with Dr. Still and was promoted, amongst his contemporaries, by Dr. John Martin Littlejohn, DO, who founded the British School of Osteopathy in London. The general treatment, based on a strong biomechanical background, was further spread in Europe by John Wernham, DO, a British osteopath and one of Littlejohn’s students. Wernham developed and taught the GOT in its original form based on the principles and philosophy of osteopathic medicine. The goals of this article are to give an historical perspective of the GOT, to describe the foundation and concepts behind it, and to provide a review of the scientific literature of this treatment approach. The GOT can be used to diagnose and directly treat somatic dysfunction using the TART principle in a clinical setting. Besides the recognized contra-indications of treating somatic dysfunction, there are no clear scientifically published findings of contraindications for the use of the GOT. Like other OMTs, the GOT needs more scientific evidence to better understand its clinical applications.

Effect of osteopathic manipulation on gait asymmetry

Context Movement and loading asymmetry are associated with an increased risk of musculoskeletal injury, disease progression, and suboptimal recovery. Osteopathic structural screening can be utilized to determine areas of somatic dysfunction that could contribute to movement and loading asymmetry. Osteopathic manipulation treatments (OMTs) targeting identified somatic dysfunctions can correct structural asymmetries and malalignment, restoring the ability for proper compensation of stresses throughout the body. Little is currently known about the ability for OMTs to reduce gait asymmetries, thereby reducing the risk of injury, accelerated disease progression, and suboptimal recovery. Objectives To demonstrate whether osteopathic screening and treatment could alter movement and loading asymmetry during treadmill walking. Methods Forty-two healthy adults (20 males, 22 females) between the ages of 18 and 35 were recruited for this prospective intervention. Standardized osteopathic screening exams were completed by a single physician for each participant, and osteopathic manipulation was performed targeting somatic dysfunctions identified in the screening exam. Three-dimensional (3-D) biomechanical assessments, including the collection of motion capture and force plate data, were performed prior to and following osteopathic manipulation to quantify gait mechanics. Motion capture and loading data were processed utilizing Qualisys Track Manager and Visual 3D software, respectively. Asymmetry in the following temporal, kinetic, and kinematic measures was quantified utilizing a limb symmetry index (LSI): peak vertical ground reaction force, the impulse of the vertical ground reaction force, peak knee flexion angle, step length, stride length, and stance time. A 2-way repeated-measures analysis of variance model was utilized to evaluate the effects of time (pre/post manipulation) and sex (male/female) on each measure of gait asymmetry. Results Gait asymmetry in the peak vertical ground reaction force (−0.6%, p=0.025) and the impulse of the vertical ground reaction force (−0.3%, p=0.026) was reduced in males following osteopathic manipulation. There was no difference in gait asymmetry between time points in females. Osteopathic manipulation did not impact asymmetry in peak knee flexion angle, step length, stride length, or stance time. Among the participants, 59.5% (25) followed the common compensatory pattern, whereas 40.5% (17) followed the uncommon compensatory pattern. One third (33.3%, 14) of the participants showed decompensation at the occipitoatlantal (OA) junction, whereas 26.2% (11), one third (33.3%, 14), and 26.2% (11) showed decompensation at the cervicothoracic (CT), thoracolumbar (TL), and lumbosacral (LS) junctions, respectively. Somatic dysfunction at the sacrum, L5, right innominate, and left innominate occurred in 88.1% (37), 69.0% (29), 97.6% (41), and 97.6% (41) of the participants, respectively. Conclusions Correcting somatic dysfunction can influence gait asymmetry in males; the sex-specificity of the observed effects of osteopathic manipulation on gait asymmetry is worthy of further investigation. Osteopathic structural examinations and treatment of somatic dysfunctions may improve gait symmetry even in asymptomatic individuals. These findings encourage larger-scale investigations on the use of OMT to optimize gait, prevent injury and the progression of disease, and aid in recovery after surgery.

Insomnia diagnosis and management: an osteopathic approach

Insomnia affects a large percentage of American adults and is among the most commonly treated medical conditions in the outpatient clinical setting. The psychological, medical and financial impact of insomnia is substantial. Research indicates that pharmacologic treatment is associated with significant risk, and clinicians should consider other modalities including cognitive behavioral therapy before prescribing medications for the treatment of insomnia. Other complementary treatments including yoga, stress management and traditional Chinese medical therapies are promising, but more research is needed. The osteopathic family physician plays an important role in diagnosis and management. An osteopathic approach to patient care is highly beneficial and includes a multifaceted evaluation when taking a patient history and osteopathic manipulative treatment (OMT) to balance autonomic tone and correct associated somatic dysfunction.

Evaluating for a correlation between osteopathic examination and ultrasonography on thoracic spine asymmetry

Context The thoracic spine is a common area of focus in osteopathic manipulative medicine (OMM) for a variety of conditions. Thoracic spine somatic dysfunction diagnosis is achieved by palpating for asymmetry at the tips of the transverse processes (TPs). Previous studies reveal that instead of following the rule of threes, the TPs of a given thoracic vertebra generally align with the spinous process (SP) of the vertebra above. Ultrasonography has been widely utilized as a diagnostic tool to monitor musculoskeletal conditions; it does not utilize ionizing radiation, and it has comparable results to gold-standard modalities. In the case of thoracic somatic dysfunction, ultrasound (US) can be utilized to determine the location of each vertebral TP and its relationship with the SP. Previous studies have investigated the correlation between OMM and ultrasonography of the cervical, lumbar, and sacral regions. However, there has been no study yet that has compared osteopathic structural examination with ultrasonographic examination of the thoracic vertebral region. Objectives To examine the relationship between osteopathic palpation and ultrasonographic measurements of the thoracic spine by creating a study design that utilizes interexaminer agreement and correlation. Methods The ClinicalTrials.gov study identifier is NCT04823637. Subjects were student volunteers recruited from the Midwestern University (MWU)—Glendale campus. A nontoxic, nonpermanent marker was utilized to mark bony landmarks on the skin. Two neuromusculoskeletal board-certified physicians (OMM1, OMM2) separately performed structural exams by palpating T2–T5 TPs to determine vertebral rotation. Two sonographers (US1, US2) separately scanned and measured the distance from the tip of the SP to the adjacent TPs of the vertebral segment below. Demographic variables were summarized with mean and standard deviation. Interexaminer agreement was assessed with percent agreement, Cohen’s Kappa, and Fleiss’ Kappa. Correlation was measured by Spearman’s rank correlation coefficient. Recruitment and protocols were approved by the MWU Institutional Review Board (IRB). Results US had fair interexaminer agreement for the overall most prominent segmental rotation of the T3–T5 thoracic spine, with Cohen’s Kappa at 0.27 (0.09, 0.45), and a total agreement percentage at 51.5%. Osteopathic palpation revealed low interexaminer agreement for the overall most prominent vertebral rotation, with Cohen’s Kappa at 0.05 (0.0, 0.27), and 31.8%. Segment-specific vertebral analysis revealed slight agreement between US examiners, with a correlation coefficient of 0.23, whereas all other pairwise comparisons showed low agreement and correlation. At T4, US had slight interexaminer agreement with 0.24 correlation coefficient, and osteopathic palpation showed low interexaminer (OMM1 vs. OMM2) agreement (0.17 correlation coefficient). At T5, there was moderate agreement between the two sonographers with 0.44 (0.27, 0.60) and 63.6%, with a correlation coefficient of 0.57, and slight agreement between OMM1 and OMM2 with 0.12 (0.0, 0.28) and 42.4%, with 0.23 correlation coefficient. Conclusions This preliminary study of an asymptomatic population revealed that there is a low-to-moderate interexaminer reliability between sonographers, low-to-slight interexaminer reliability between osteopathic physicians, and low interexaminer reliability between OMM palpatory examination and ultrasonographic evaluation of the thoracic spine.

Application of computer stabilometric technologies with biofeedback in patients with lumbosacral pain

Introduction. Low back pain is one of the most common sufferings of modern humans. In developed countries, such manifestations are a serious medical and economic problem. Lumbosacral pain in many cases is caused by the occurrence of somatic dysfunction of the bones of the pelvis and sacrum. The main methods of treatment are prescribing drug therapy and non-drug treatment. Today, osteopathic techniques are highly effective for the diagnosis and correction of somatic dysfunctions of the pelvic region. Such treatment in patients with pain in the lower back helps to reduce pain and restore the functional state of patients. Equally important are computer technologies with biofeedback (BFB) with the possibility of effective correction of proprioceptive innervation and muscle-tonic syndromes. The stabilometric platform allows you to register the parameters of the static-dynamic function of support and balance maintenance. The resulting changes in the position of the sacrum and pelvic bones create a distortion of proprioceptive somatosensory afferentation, postural tonic reflexes of the axial skeleton and limbs are blocked, the sequence of activation of the motor units of the locomotor apparatus is disrupted, the mechanisms for maintaining support and walking change. The aim — to study the effectiveness of using a stabiloplatform with biofeedback in the diagnostic mode of coordinating and static-dynamic disorders in patients with somatic dysfunctions of the pelvic and sacral bones in a training mode in combination with osteopathic correction for pain in the lumbosacral region. Materials and methods. In a prospective controlled study in patients with lumbosacral pain with somatic dysfunctions of the pelvic bones, the results of treatment were analyzed in 66 patients aged 23–56 years. Diagnosis of dysfunctions of the iliac bones was carried out according to the generally accepted rules of osteopathic examination — osteopathic examination and determination of the position of bone landmarks. The observed patients were divided into groups and subgroups depending on the type of dysfunction. The main group consisted of patients with clinical and osteopathic signs of somatic dysfunctions of the pubic bone and ilium. The patients were followed up for 14 days. The observation and treatment program included: osteopathic correction of diagnosed somatic dysfunction and stabilometric examination (3 control points) with a training regimen (3 sessions). Stabilometric testing was carried out at the stage of diagnosis and selection of patients for inclusion in the study. Re-examination was carried out 14 days after the moment of treatment. The clinical effect was compared with the results of stabilometric tests. In addition, the intensity of the pain syndrome and the severity of muscle-tonic reactions were analyzed. According to the results of the test regime, the stability in the «eyes open» and «eyes closed» modes was assessed. Results. A decrease in the intensity of pain is achieved, normalization of the balance in axial parameters with an improvement in the function of coordination of movements is noted. The Romberg coefficient decreases most significantly in somatic dysfunctions of the iliac bones in the position of anterior rotation without a significant difference in lateralization: on the right, a decrease from 570 ± 12% to 295 ± 23% and on the left from 550 ± 22 to 260 ± 25% (p <0.05). Conclusion. In the event of somatic dysfunctions of the pelvic bones with lumbosacralgia, the combined use of osteopathic correction and physiotherapy exercises on a stabiloplatform in a training mode with biofeedback has a significant effect. The training regimen promotes pain regression in acute and chronic pain. The best results have been achieved in patients with dysfunction in the anterior rotation of the ilium. Stabilometric testing in the diagnostic mode allows you to obtain objective data on the nature of imbalance and imbalance. The training regime ensures the achievement of a therapeutic result in 3 sessions and can be used in inpatient and outpatient conditions of medical institutions.

Integrated Osteopathic-Neurologic Exams With Musculoskeletal Treatment: The ONE Approach

The global burden of neurologic disorders are a leading cause of disability and death worldwide and has increased the demand for treatments and rehabilitation. Our proposed integrated Osteopathic-Neurological Examination (ONE) provides the physician with expanded diagnostic and point of care treatment modalities while allowing the physician to make a more tangible impact in patient care. By incorporating the osteopathic structural somatic examination with the complete neurological evaluation, somatic dysfunction, occurring as a consequence or independent of neurologic injury, can be identified and treated using osteopathic manipulative techniques at time of visit. Utilizing the proposed integrated examination, the physician can determine the interplay between structural and neurological findings to identify patterns of change that coincide with more specific diagnoses and the chronicity of a condition. Tangible benefits from the ONE approach translate to more accurate clinical assessment and enhanced patient and physician satisfaction.

Terminology of injuries in osteopathy and other medical disciplines

There is presented a review of the literature on the concepts of «osteopathic damage», «somatic dysfunction», «trauma», «damage». The similarities and differences of these terms in osteopathy, traumatology and forensic medicine are shown. In order to achieve an interdisciplinary understanding in osteopathy, along with the original and new terminology, the use of the historically established terminology of classification of external damaging factors is proposed.

What Does the Body Communicate With Postural Oscillations? A Clinical Investigation Hypothesis

The evolution of the foot and the attainment of the bipedia represent a distinctive characteristic of the human species. The force of gravity is dissipated through the tibial astragalic joints, and the movement of the ankle is manifested on a sagittal plane. However, this is in contrast with other studies that analyze the straight station in bipodalic support of the body. According to these studies, the oscillations of the body dissipated by the articulation of the ankle are greater on a frontal plane than on a sagittal plane. Probably, this can be deduced by analyzing the concept of “cone of economy (COE) and equilibrium;” a cone that has its base with the oscillations described by the 360° movement performed by the head and has its apex that supports polygon defined by the tibio-astragalic articulation. The purpose of this study was to evaluate a kind of communication between the oscillations of the COE and equilibrium and the main sphere of somatic dysfunction (structural, visceral, or cranial sacral), assessing the reliability of the “fascial compression test.” The implications of this connection have been considered, while grounding the hypothesis in the ability of the human body to maintain its center of mass (COM) with minimum energy expenditure and with minimum postural influence. At the same time, the fascial compression test provides a dominant direction of fascial compartments in restriction of mobility.

Proprioceptive Coherence: An Expanded View of the Mechanics Behind the Indirect Method and the Introduction of an Innovative Variation

Proprioceptive coherence is proposed as a novel osteopathic treatment technique whereby the desired technique response is rapid, resulting from the sensory integration of multiple diverse proprioceptive, somatosensory, nociceptive, neuroendocrine elements contributing to focal somatic dysfunction. Volitional components involving the cerebral cortex, emotional contributions from the limbic system as well as prioritization of the motor responses to dysfunction contribute to mechanisms putatively involved with the technique. The technique has a unique obligatory focus on a temporal element. To better comprehend this treatment approach, diverse determinants of somatic dysfunction such as altered proprioceptive input, muscular influences, nociception, spinal cord processing and higher level central processing are discussed including muscular, aspects of mechanical transduction and tensegrity, nociception, spinal cord, and central processing. The diagnostic component of this technique involves identification of primarily interoceptive, proprioceptive and somatosensory related tissue alterations and considers a secondary exteroceptive contribution. The treatment phase is dictated by perception of precise balancing of localized forces on the area of dysfunction. A mandatory physician participation is dictated by the feed forward unique chronoception component. At the completion of the technique, rapid therapeutic effects are perceived by both the physician and the patient. This paper is intended to appeal to the scientist in all of us; the lover of osteopathic manipulative techniques, and the healer we embrace as practicing osteopathic physicians. To help establish proprioceptive coherence as a novel technique, a comparison to common forms of osteopathic treatment based upon the indirect method is presented. It is proposed that proprioceptive coherence is a novel technique with unique mechanisms however others may consider the technique as a refinement of existing indirect methods.

Stimulating the Use of OMT in Primary Care Offices Via Point-of-Care Reminders

Primary care physicians, especially in family medicine, are more prone to use osteopathic manipulative treatment (OMT) than other specialists; however, barriers to OMT use exist. The purpose of this study is to evaluate if the frequency of OMT use in a family medicine outpatient setting is influenced by having posters promoting OMT in exam rooms and waiting rooms. Methods: OMT posters were placed in two of four offices in an academic family medicine practice. Offices without posters served as the control group. Billing patterns were examined for the five months prior to and after poster placement. Report parameters included: age, gender, ethnicity, CPT code for OMT and somatic dysfunction ICD-10 codes. Results: Data before and after poster placement were compared. Results showed a positive correlation between posters advertising OMT and OMT use. There was a 6.5% increase in OMT use in the offices that had posters advertising OMT. Conclusion: This research showed that placing OMT posters in select family medicine offices resulted in an increase in OMT use. Possibilities for this increase include patients becoming more aware of the benefits of OMT and/or simply reminding osteopathic physicians of the benefits of OMT. Increased OMT utilization could lead to a decrease in pain medication prescribing and an increase in functionality through conservative measures.